UNIT 10 Pediatric Head Trauma & NEUROSENSORY Flashcards
Which of the following places should you as a nurse should be suspicious if you 8-month-old patient appears with bruising? SELECT ALL THAT APPLY
A. Toe nails
B. Buttox
C. Ears
D. Hand
E. Neck
F. Torso
C. Ears
E. Neck
F. Torso
What can trigger an individual to cause pediatric head trauma to a child
◦ Crying baby
◦ Misbehavior
◦ Argument/conflict
◦ Toilet training
◦ Parental stressors
◦ Discipline gone awry
What families are overlooked when it comes to pediatric abuse?
◦ Caucasian families
◦ “Intact” families
◦ Middle class, well educated families
◦ Families perceived to be like our own
◦ Very young infants
◦ Infants with non-specific symptom
What is the nurses responsibly when it comes to Pediatric Trauma and the prevention thereof?
◦ Report to CPS if suspected abuse
◦ Document signs/symptoms of abuse
◦ Take pictures of injuries
◦ Document information from caregiver when you have
suspicions
◦ Document observations of the parent and child,
including interactions
◦ Help parents understand that it is normal For babies to cry
◦ To feel frustrated and need help to cope
◦ Be a resource for the family
◦ Talk openly about dangers of shaking a baby
What can you do to soothe a a crying baby to prevent shaking syndrome?
- change diaper
-feed baby
-assess if the baby is sick or injured - rock, walk , or dance with baby
-drive with baby in car seat
-white noise(distraction music)
-if you are frustrated from the baby walk away, put baby in crib that is clutter free
What is Abusive head trauma commonly referred to?
Also known as Shaken Baby Syndrome
What is the number one risk factor for Shaken Baby Syndrome?
Caused by violent shaking
* #1 risk factor: crying
* Damage caused by shearing forces in head
* Often no external injuries present
* Medical attention sought for apnea, irritability, lethargy, seizure
Nursing consideration when talking to pediatric patients about abuse?
- Provide private place to talk
- Do not promise not to tell
- Avoid leading questions
- Red flags for abuse:
- Parent answers questions asked of child
- Injury does not match story; changing stories
- Parent/child stories do not match
- Inappropriate response from child
- Parent refusing treatment or testing
What is the number one priority in a pediatric patient who is diagnosed with Attention Deficit Hyperactivity Disorder?
Safety due to impulsiveness
S/S of ADHD
Behavioral disorder characterized by develop-
mentally inappropriate degrees of inattention,
overactivity, and impulsivity
Fidgets with hands or feet or squirms in the seat
Easily distracted with external or internal stimuli
3. Diffculty with following through on instructions
4. Poor attention span
5. Shifts from one uncompleted activity to another
6. Talks excessively
7. Interrupts or intrudes on others
8. Engages in physically dangerous activities without considering the possible consequences
How do manage ADHD
- Behavioral therapy; positive reinforcement
- Organizational charts
- Frequent breaks
- Medication(Methylphenidate ) Cns depressant
- Safety measures due to impulsivity
Is Down syndrome congenital or acquired?
congenital
Trisomy 21
* Etiology: unknown. Risk statistically greater if maternal age over
35
Your pediatric patient who is 2 months old has comes in for a check up due to a possibility of having downsydrome. Which of the following manifestations will confirm this suspicion?
A. Downward started eyes
B. hypertonicity
C. hypo flexibility
D. depressed nasal bridge
D. depressed nasal bridge
S/S OF DOWNSYNDROME
* Low birth weight
* Hypotonicity
* Short stature
* Hyperflexibility
* Depressed nasal bridge
* Protruding tongue
* Short, stubby digits
* Upward slanted eyes
Your pediatric patient has came him for a check up. The mother states that her child has had difficulty making eye contact with her. Which of the following disorders would you suspect this child to have?
A. Kawasaki syndrome
B. Ventricular Septal defect
C. Autism
D. Attention Deficit Hyperactivity Disorder
C. Autism
S/S of autism
Manifestations: Inability to maintain eye contact
- Failure to interact socially, communicate appropriately
- Early red flags: no smile by 3 mos,
*no eye contact,
*no babbling by 12
mos, - no words by 16 mo
How do you manage autism?
- Determine the child’s routines, habits, and preferences, and maintain consistency as much as
possible. - Determine the specific ways in which the child
communicates, and use these methods. - Avoid placing demands on the child.
- Implement safety precautions as necessary for
self-injurious behaviors such as head banging. - Initiate referrals to special programs as required.
- Provide support to parent
DECREASE STIMULATION
What is a classical sign of a brain tumor
Headache (especially upon awakening), vomiting, nystagmus, vision
changes
Your pediatric patient’s mother has noticed that the front center of the top of head has gotten bigger she described it as a “bulged appearance”. What disorder do you suspect can be going on with the patient?
A. Sickle cell disorder
B. Increased Intracranial pressure
C. Hemophilia A
D. Kawasaki syndrome
B. Increased Intracranial pressure
Increased Intracranial Pressure
Pressure accumulated in cranium due to CSF or blood
* Fontanel accommodates for some increase in infancy
* Early manifestations may be subtle
Signs and symptoms of Increased Intracranial pressure
Manifestations
* Bulging fontanels
* Shrill cry
* Separated suture lines
* Increased head circumference
* Irritability
* Distended scalp veins
* Drowsiness Headache
* Lethargy
* Vomiting (forceful)
How do you manage Increased Intracranial Pressure
Management:
* Direct ICP monitoring
* Osmotic diuretics (Mannitol)
* Positioning- HOB 15-30
* Cluster care(DO EVERYTHING AT ONCE TO LESSON STIMULATION)
* Quiet, dimly lit environment
* No airway suctioning unless necessary
* Strict I&O
What I the number one first nursing intervention. when you suspect that a child may have head injury?
Neurologic exam to check neurological status
Vital signs
* Temperature
* BP/HR- changes in these are more important than direction they are
headed
* RR- often deep and irregular
* Pupils- PERRLA?
* LOC
* Motor function- spontaneous vs to painful stimuli
* Posturing- occurs when control of motor function is lost
Your pediatric patient has just entered the trauma unit from a motor vehicle accident. You notice a postering that shows that his hands are centered and held tightly in his core/body. What would you suspect this child posturing to be?
A.Decorticate
B.Decerebrate
A.Decorticate
What is the definition of Decorticate posturing
Rigid flexion with arms held tightly
to body; legs extended and rotated
inward
What is the definition of Decerebrate posturing
Rigid extension and pronation of
arms and legs
Nursing interventions and considerations for an unconscious child
- Ensure adequate circulation, clear airway, effective breathing
- Frequent neuro assessments
- VS assessments
- Pain assessment and management
- Quiet, dimly lit environment
- Proper positioning
What is a hallmark sign of a concussion?
Confusion and amnesia after injury are hallmark signs
What nursing teaching would help prevent head injuries in children?
Management of head injuries
* Neuro checks (even while sleeping)
* Mild injuries can be cared for at home
* Teach importance of helmets
What does submersion injuries consist of?
A. Injuries that occur through submarines
B. Injuries that only occur in the ocean when a child is left unattended
C. Injuries that can take place in any body of water, when a child is left unattended (drowning).
D. Injuries that take place in the school place.
C. Injuries that can take place in any body of water, when a child is left unattended (drowning).
Distress caused from submersion in liquid that results in death
(or survival for at least 24 hours)
What time frame does the brain experience irreversible trauma when an individual is submerged in water or without oxygen?
A. 1 minute
B. 2 minutes
C. 4 minutes
D. 30 minutes
C. 4 minutes
Brain suffers irreversible damage after 4 mins without oxygen; heart
and lungs after 30 mins
Managment of Submersion Injuries
Management: RESTORE OXYGEN delivery to tissues
NO 2L/MIN
100% OXYGEN
- Monitor for at least 6-8 hours after injury
- Support the family
- PREVENTION! DO NOT LEAVE CHILD UNATTENDED IN WATER AT ALL
What is a classical sign of Meningitis?
Nuchal rigidity (stiff neck)
Positive Kerning
and Brudzinski sign
How does the kerning sign present?
The appearance of resistance or pain during extension of the patient’s knees beyond 135 degrees constitutes a positive Kernig’s sign
How does the Brudzinski sign present?
One of the physically demonstrable symptoms of meningitis is Brudzinski’s sign. Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
What is the proper precaution for a patient with Meningitis ?
A. Neutropenic isolation
B. Droplet isolation
C. Airborn isolation
D. Contact isolation
B. Droplet isolation
S/S of Meningitis
- Fever,
chills - Seizures
- Headache
- Positive Kerning and Brudzinski sign
- Nuchal rigidity
- Photophobia
Would a patient with head injury be sensitive to light?
A. Yes
B. No
A. Yes
Management of Meningitis
Management
* Isolation (droplet)
* Antimicrobial therapy
* Reduce increased ICP
* Fever reduction
* Seizure control
* Prevention: Vaccinations
* HiB, pneumococcal
Reyes Syndrome
Metabolic encephalopathy with liver involvement
* Etiology: unknown, but often follows viral illness
* Manifestations: fever; profuse, effortless vomiting; lethargy that
progresses to delirium; seizures; coma; ICP and death
* Diagnostics: Liver biopsy
* Management: early diagnosis and aggressive supportive care
* Care similar to increased ICP
* Strict I&O
Your pediatric patient has been admitted due to having a viral illness and his moy=ther gave him aspirin to bring the fever down. What sign and symptoms would you suspect this patient to present?
A. seizures
B. Abdominal distention
C. Hematoma
D.decreased intracranial pressure
A. seizures
Manifestations: fever;
profuse, effortless vomiting; l
ethargy that
progresses to delirium;
seizures;
coma; ICP and death
Management of Reyes Syndrome
Management: early diagnosis and aggressive supportive care
* Care similar to increased ICP
* Strict I&O
- Direct ICP monitoring
- Osmotic diuretics (Mannitol)
- Positioning- HOB 15-30
- Cluster care(DO EVERYTHING AT ONCE TO LESSON STIMULATION)
- Quiet, dimly lit environment
- No airway suctioning unless necessary
- Strict I&O
What is the priority action for a pediatric patient who is experiencing a seizure?
SAFETY
REMOVE ALL CLUTTER SURROUNDING THEM THAT CAN CAUSE HARM
Can meningitis cause a seizure?
Etiology: trauma, meningitis, may be idiopathic of - SEIZURES
Management of seizures
Management: during seizure- SAFETY!
* Control meds: antiepileptics
* Rescue meds: intranasal midazolam, buccal lorazepam, rectal diazepam
* STRICT ketogenic diet
* Surgery
* Vagus nerve stimulatoN
What is Hydrocephalus
Imbalance in production and
absorption of CSF
* Patho: impaired absorption of
CSF or blockage in ventricles due
to malformation, tumor
S/S of Hydrocephalus
- Head enlargement, bulging
fontanel - Prominent scalp veins
- Lethargy
- High pitched cry
- Lethargy, irritability
Management of Hydrocephalus
Management: surgical- VP shunt
placement
* Post op care: monitor for shunt
malfunction or infection
* S/S increased ICP, vomiting, fever,
seizures
* Teach parents to monitor for above;
also, constipation may cause
malfunction
Your pediatric patient has recently undergone a VP shunt surgery. You notice that his fontanels are bulging again. What is the nurses priority action?
Contact the doctor
What is cerebral palsy?
Group of permanent disorders affecting motor movements, communication, cognition, behavior
* Abnormal muscle tone & coordination are primary disturbance
S/S of cerebral palsy
- Persistent primitive reflexes
- Stiff, rigid posture
- Arching back, pushing away
- Floppy tone
- Unable to sit unsupported by 8 mos, no smile at 3 mos
- Feeding difficulties- tongue thrusting, choking
Management of Cerebral palsy
Management: interdisciplinary care
* Common problems with CP
* Dental caries
* Constipation
* Chronic UTI
* Feeding difficulties
* Musculoskeletal issues
- Goals of therapy: establish and
maintain locomotion, communication
and self-help skills
The parents of a child recently diagnosed with cere- bral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophysi- ological process?
1. An infectious disease of the central nervous sys- tem
2. An inflammation of the brain as a result of a viral illness
3. A chronic disability characterized by impaired muscle movement and posture
4. A congenital condition that results in moderate to severe intellectual disabilities
- A chronic disability characterized by impaired muscle movement and posture
The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect?
1. Meningitis
2. Spinal cord injury
3. Intracranial bleeding
4. Decreased cerebral blood ow
- Meningitis
The nurse is reviewing the record of a child with increased intracranial pressure from a head injury and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing?
1. Flaccid paralysis of all extremities
2. Adduction of the arms at the shoulders
3. Rigid extension and pronation of the arms and legs
4. Abnormal flexion of the upper extremities and extension and adduction of the lower extremities
- Rigid extension and pronation of the arms and legs
A child is diagnosed with Reyes syndrome
The nurse creates a nursing care plan for the child and would include which intervention in the plan?
1. Assessing hearing loss
2. not monitoring urine output
3. Changing body position every 2 hours
4. Providing a quiet atmosphere with dimmed lighting
- Providing a quiet atmosphere with dimmed lighting
What is the proper positioning for a patient with spina bifida?
Management: Prevention with folic
acid
* C-Section birth
* Keep sac intact
* Prep baby for closure
* Infant kept prone
* Diapering contraindicated
* Parental bonding
NO DIAPERSSS
Muscular Dystrophy
Duchenne muscular dystrophy (DMD) most common type in
childhood
- Etiology: X-linked recessive trait
- Manifestations: gradual muscle weakness & atrophy appears by
age 3-7 - Management: No cure. Prednisone used to decrease
progression of weaknes
The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) needs to be placed at the child’s bedside?
1. Emergency cart
2. Tracheotomy set
3. Padded tongue blade
4. Suctioning equipment and oxygen
- Suctioning equipment and oxygen
- The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of trans mission of this infection, which precautionary in- tervention would be included in the plan of care?
- Maintain enteric precautions.
- Maintain neutropenic precautions.
- No precautions are required as long as antibiotics have been started.
- Maintain respiratory droplet isolation precautions for atleast 24 hours after the initiation of antibiotics.
- Maintain respiratory droplet isolation precautions for atleast 24 hours after the initiation of antibiotics.
An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period?
1. Test the urine for protein.
2. Reposition the infant frequently.
3. Provide a stimulating environment.
4. Assess blood pressure every 15 minutes.
- Reposition the infant frequently.
Hydrocephalus occurs as a result of an imbal- ance of cerebrospinal fluid absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased intracra- nial pressure (ICP). In infants with hydrocephalus, the head grows at an abnormal rate, and if the infant is not reposi- tioned frequently, pressure ulcers can occur on the back and side of the head.
